The present invention relates to a system and method for automating physician notes within an entire system of patient care and patient monitoring. For purposes of this application, the “patient care system” refers generally to the system in a hospital or other care facility that provides health care services to patient. Such a system comprises, without limitation, emergency rooms, operating rooms, laboratories, hospital rooms, data processing systems, monitoring equipment, administrative systems and billing systems.
While the severity of illness of ICU and other hospitalized patients over the past 15 years has increased dramatically, the level of and type of physician coverage has remained constant. Most hospitalized patients receive brief minutes of attention during morning rounds. During the remainder of the day and night, nurses are the primary caregivers, with specialists called only after patient conditions have started to deteriorate. One result of this mismatch between severity of illness and physician coverage is a high prevalence of avoidable errors that result in clinical complications. Exacerbating the problem is the inability of present days systems to incorporate and disseminate information derived from doctors and other hospital based physicians through the patient care system so that all observations and diagnoses are available to various hospital personnel in a timely way. In 1998, an Institute of Medicine Roundtable determined that avoidable patient complications were the single largest problem in medical care delivery. In another prominent 1998 study of 1000 patients, 46% experienced an avoidable adverse event in care, with 40% of these errors resulting in serious disability or death. Techniques that can limit these problems would be beneficial indeed, not only to patients but to the hospitals themselves.
The physicians who treat critically ill patients are in critically short supply. Numerous studies have shown that intensivists (physicians who have trained and board certified in Critical Care Medicine) can markedly improve patient outcomes. However, only one-third of all critically ill patients ever have an intensivist involved in their care, and the number of intensivists would need to increase seven-fold (nationally) to provide 24-hour coverage to all critically ill patients. With the rapid aging of the population, this shortfall of expertise is going to increase dramatically.
Even where intensivists are present (and especially where they are not), patients suffer from unnecessary variation in practice. There is little incentive for physicians to develop and conform to evidence-based best practices (it takes significant work and a change in behavior to develop and implement them). This variation contributes to sub-optimal outcomes, in both the quality and cost of care delivered to hospitalized patients.
What is needed, and is beginning to be fielded with great success, is a critical care regimen offered to critically ill patients. Such a system is described in Application for Letters patent Ser. No. 09/443,072, entitled “System And Method For Providing Continuous, Expert Network Critical Care Services From A Remote Location(S)” which is incorporated herein by reference. Rather than the traditional consultative model where a periodic visit takes place and the doctor then goes away, a more active 24-hour intensivist managed care is instituted via remote monitoring of geographically disparate healthcare locations. Such technology leverages the intensivists' expertise and standardizes the care afforded to critically ill patients. Further, continuous feedback to improve the practice of intensivists is necessary so that timely interventions can occur to minimize any adverse events. But even more can be done.
Attempts to automate various aspects of patient care have been the subject of various inventions. For example, U.S. Pat. No. 5,868,669 to Iliff was issued for “Computerized Medical Diagnostic and Treatment Advice System.” The disclosed invention is for a system and method for providing computerized knowledge based medical diagnostic and treatment advice to the general public over a telephone network.
U.S. Pat. No. 5,823,948 to Ross, Jr. et al was issued for “Medical Records Documentation, Tracking and Order Entry System”. The disclosed invention is for a system and method that computerizes medical records, documentation, tracking and order entries. A teleconferencing system is employed to allow patient and medical personnel to communicate with each other. A video system can be employed to videotape a patient's consent.
U.S. Pat. No. 4,878,175 to Norden-Paul et al. was issued for “Method for Generating Patient-Specific Flowsheets By Adding/Deleting Parameters.” The disclosed invention is for an automated clinical records system for automated entry of bedside equipment results, such as an EKG monitor, respirator, etc. The system allows for information to be entered at the bedside using a terminal having input means and a video display.
U.S. Pat. No. 5,544,649 to David et al. was issued for “Ambulatory Patient Health Monitoring Techniques Utilizing Interactive Visual Communications.” The disclosed invention is for an interactive visual system, which allows monitoring of patients at remote sites, such as the patient's home. Electronic equipment and sensors are used at the remote site to obtain data from the patient, which is sent to the monitoring site. The monitoring site can display and save the video, audio and patient's data.
U.S. Pat. No. 5,867,821 to Ballantyne et al. was issued for “Method and Apparatus for Electronically Accessing and Distributing Personal Health Care Information and Services in Hospitals and Homes.” The disclosed invention is for an automated system and method for distribution and administration of medical services, entertainment services, and electronic health records for health care facilities.
U.S. Pat. No. 5,832,450 to Myers et al. was issued for “Electronic Medical Record Using Text Database.” The disclosed invention is for an electronic medical record system, which stores data about patient encounters arising from a content generator in freeform text.
U.S. Pat. No. 5,812,983 to Kumagai was issued for “Computer Medical File and Chart System.” The disclosed invention is for a system and method that integrates and displays medical data in which a computer program links a flow sheet of a medical record to medical charts.
U.S. Pat. No. 4,489,387 to Lamb et al. was issued for “Method and Apparatus for Coordinating Medical Procedures.” The disclosed invention is for a method and apparatus that coordinates two or more medical teams to evaluate and treat a patient at the same time without repeating the same steps.
U.S. Pat. No. 4,731,725 to Suto et al. was issued for “Data Processing System which Suggests a Pattern of Medical Tests to Reduce the Number of Tests Necessary to Confirm or Deny a Diagnosis.” The disclosed invention is for a data processing system that uses decision trees for diagnosing a patient's symptoms to confirm or deny the patient's ailment.
U.S. Pat. No. 5,255,187 to Sorensen was issued for “Computer Aided Medical Diagnostic Method and Apparatus.” The disclosed invention is for an interactive computerized diagnostic system which relies on color codes which signify the presence or absence of the possibility of a disease based on the symptoms a physician provides the system.
U.S. Pat. No. 5,839,438 to Chen et al. was issued for “Intelligent Remote Visual Monitoring System for Home Health Care Service.” The disclosed invention is for a computer-based remote visual monitoring system, which provides in-home patient health care from a remote location via ordinary telephone lines.
U.S. Pat. No. 5,842,978 to Levy was issued for “Supplemental Audio Visual Emergency Reviewing Apparatus and Method.” The disclosed invention is for a system that videotapes a patient and superimposes the patient's vital statistics onto the videotape.
While these inventions provide useful records management and diagnostic tools, none of them provides a comprehensive method for inputting physician notes and populating patient care databases in real time regardless of where and when those physician notes are generated. In short, the inventions noted above are NOT designed for highly integrated hospital care.
What would be useful is a system and method for providing physician notes in a convenient manner, and integrating those notes throughput the patient care system whether it be for routine care or for care for the critically ill. Information from the physician notes (i.e. observations, thinking, and clinical plans for patients) would be immediately available to hospital personnel at all levels from administrative to those dealing directly with patients. Further, such information entered by a physician would be re-used to the maximum extent and in the most effective manner to provide information necessary for patient care and related administrative services.